Document Detail

Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis.
MedLine Citation:
PMID:  12591829     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Clinical guidelines currently suggest that transthoracic echocardiography (TTE) be carried out in all patients with suspected endocarditis, but the use of TTE where there is a low probability of infective endocarditis has a poor diagnostic yield. This screening approach may no longer be appropriate.
OBJECTIVE: To examine whether clinical criteria might aid decision making with respect to the use of TTE in possible endocarditis.
DESIGN: A retrospective review of patient records.
SETTING: Cardiology department of a tertiary referral centre.
PATIENTS: 500 consecutive hospital inpatients referred for TTE to exclude endocarditis.
MAIN OUTCOME MEASURES: Evidence of endocardial vegetations on TTE and the presence of predetermined clinical criteria that may predispose to, or be suggestive of, endocarditis.
RESULTS: Evidence of infective endocarditis was detected on echocardiography in 43 of the 500 patients (8.6%). In 239 patients (48%), vegetations and certain prespecified clinical criteria were both absent. These criteria were: vasculitic/embolic phenomena; the presence of central venous access; a recent history of injected drug use; presence of a prosthetic valve; and positive blood cultures. The collective absence of these five criteria indicated a zero probability of TTE showing evidence of endocarditis.
CONCLUSIONS: The use of simple clinical criteria during the decision making process may avoid many unnecessary TTE examinations in hospital inpatients with a low probability of endocarditis.
K Greaves; D Mou; A Patel; D S Celermajer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  89     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-02-19     Completed Date:  2003-03-14     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  273-5     Citation Subset:  AIM; IM    
Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia.
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MeSH Terms
Analysis of Variance
Decision Making
Echocardiography / standards
Endocarditis, Bacterial / ultrasonography*
Heart Valve Diseases / ultrasonography
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Comment In:
Heart. 2003 Nov;89(11):1283-4   [PMID:  14594876 ]

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